OBJECTIVE: To investigate platelet count trajectories after induction therapy with venetoclax combined with azacitidine (VA regimen) in newly diagnosed AML patients and further analyze its clinical significance. METHODS: Clinical date of 50 newly diagnosed AML patients who received VA treatment from March 2020 to July 2023 in Department of Hematology of the First Hospital of Lanzhou University were retrospectively collected. The platelet trajectories after induction chemotherapy were constructed by using group-based trajectory modeling. To study the association between diverse trajectories of platelet counts and compound complete remission (cCR) rate, overall response rate (ORR), minimal residual disease (MRD) negative rate and overall survival (OS) rate. The Cox proportional hazard model was used to evaluate the relationship between platelet trajectory and OS. The logistic regression was used to analyze the influence of individual characteristics on platelet trajectory. RESULTS: Two platelet trajectories were identified based on the model, including platelet slowly increased group (n=31, 62.0%) and platelet rapidly increased group (n=19, 38.0%). There were statistically significant differences in cCR rate, ORR and OS rate between platelet slowly increased group and platelet rapidly increased group (all P < 0.05). The Cox regression analysis showed that platelet rapidly increased group was associated with a decreased risk of mortality compared with platelet slowly increased group (HR=0.153, 95%CI : 0.045-0.527, P =0.003). Logistic regression analysis showed that IDH1/2 mutation (OR =3.908, 95%CI : 1.023-14.923, P =0.046) and platelet transfusion (OR =0.771, 95%CI : 0.620-0.959, P =0.020) were independent influencing factors of platelet trajectory. CONCLUSION The dynamic trajectory of platelet counts in newly diagnosed AML patients who received VA treatment can serve as a significant indicator to observe the efficacy and prognosis. The platelet rapidly increased is an independent protective factor for good prognosis. TheIDH1 /2 mutation and platelet transfusion are independent influencing factors of platelet trajectory.
Humans ; Leukemia, Myeloid, Acute/blood* ; Sulfonamides/administration & dosage* ; Azacitidine/therapeutic use* ; Platelet Count ; Retrospective Studies ; Bridged Bicyclo Compounds, Heterocyclic/administration & dosage* ; Male ; Female ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Induction Chemotherapy ; Survival Rate

Acute myeloid leukemia (AML) is the most common type of acute leukemia in adults. Isocitrate dehydrogenase (IDH) is a key enzyme in the tricarboxylic acid cycle and one of the common mutated genes in AML. Although the 2022 version of the ELN guidelines suggests that IDH mutations cannot be used as a separate prognostic stratification indicator, multiple studies have indicated that IDH mutations have prognostic significance for AML. Early identification of IDH mutations and selection of appropriate treatment options are crucial. This review summarizes the research progress on the characteristics, carcinogenic mechanisms, prognosis of IDH mutations in AML patients, and treatment options, in order to provide reference for further improving the prognosis of IDH -mutated AML patients.
Humans ; Isocitrate Dehydrogenase/genetics* ; Leukemia, Myeloid, Acute/genetics* ; Mutation ; Prognosis

BACKGROUND: Based on the China-VHD database, this study sought to develop and validate a Valvular Heart Disease- specific Age-adjusted Comorbidity Index (VHD-ACI) for predicting mortality risk in patients with VHD. METHODS & RESULTS: The China-VHD study was a nationwide, multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018. After excluding cases with missing key variables, 11,459 patients were retained for final analysis. The primary endpoint was 2-year all-cause mortality, with 941 deaths (10.0%) observed during follow-up. The VHD-ACI was derived after identifying 13 independent mortality predictors: cardiomyopathy, myocardial infarction, chronic obstructive pulmonary disease, pulmonary artery hypertension, low body weight, anaemia, hypoalbuminaemia, renal insufficiency, moderate/severe hepatic dysfunction, heart failure, cancer, NYHA functional class and age. The index exhibited good discrimination (AUC, 0.79) and calibration (Brier score, 0.062) in the total cohort, outperforming both EuroSCORE II and ACCI (P < 0.001 for comparison). Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694 (95% CI: 0.665-0.723) for 2-year mortality prediction. VHD-ACI scores, as a continuous variable (VHD-ACI score: adjusted HR (95% CI): 1.263 (1.245-1.282), P < 0.001) or categorized using thresholds determined by the Yoden index (VHD-ACI ≥ 9 vs. < 9, adjusted HR (95% CI): 6.216 (5.378-7.184), P < 0.001), were independently associated with mortality. The prognostic performance remained consistent across all VHD subtypes (aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid valve disease, mixed aortic/mitral valve disease and multiple VHD), and clinical subgroups stratified by therapeutic strategy, LVEF status (preserved vs. reduced), disease severity and etiology. CONCLUSION The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.

OBJECTIVES: Prolonged invasive mechanical ventilation is associated with increased risks of severe complications such as retinopathy of prematurity and bronchopulmonary dysplasia. Although neonatal intensive care unit (NICU) follow the principle of early extubation, extubation failure rates remain high, and reintubation may further increase the risk of adverse outcomes. This study aims to identify risk factors and short-term prognosis associated with first extubation failure in neonates, to provide evidence for effective clinical intervention strategies. METHODS: Clinical data of neonates who received invasive ventilation in the NICU of Children's Hospital of Nanjing Medical University from January 1, 2019, to December 31, 2021, were retrospectively collected. Neonates were divided into a successful extubation group and a failed extubation group based on whether reintubation occurred within 72 hours after the first extubation. Risk factors and short-term outcomes related to extubation failure were analyzed. RESULTS: A total of 337 infants were included, with 218 males (64.69%). Initial extubation failed in 34 (10.09%) infants. Compared with the successful extubation group, the failed extubation group had significantly lower gestational age [(31.37±5.14) weeks vs (34.44±4.07) weeks], age [2.5 (1.00, 8.25) h vs 5 (1.00, 22.00) h], birth weight [(1 818.97±1128.80) g vs (2 432.18±928.94) g], 1-minute Apgar score (6.91±1.90 vs 7.68±2.03), and the proportion of using mask oxygenation after extubation (21% vs 46%) (all P<0.05). Conversely, compared with the successful extubation group, the failed extubation group had significantly higher rates of vaginal delivery (59% vs 32%), caffeine use during mechanical ventilation (71% vs 38%), dexamethasone use at extubation (44% vs 17%), the highest positive end-expiratory pressure level within 72 hours post-extubation [6(5.00, 6.00) cmH₂O vs 5 (0.00, 6.00) cmH₂O] (1 cmH₂O=0.098 kPa), the highest FiO₂ within 72 hours post-extubation [(34.35±5.95)% vs (30.22±3.58)%], and duration of noninvasive intermittent positive pressure ventilation after extubation [0.5 (0.00, 42.00) hours vs 0 (0, 0) hours] (all P<0.05). Multivariate analysis identified gestational age <28 weeks (OR=5.570, 95% CI 1.866 to 16.430), age at NICU admission (OR=0.959, 95% CI 0.918 to 0.989), and a maximum FiO₂≥35% within 72 hours post-extubation (OR=4.541, 95% CI 1.849 to 10.980) as independent risk factors for extubation failure (all P<0.05). Additionally, the failed extubation group exhibited significantly higher incidences of necrotizing enterocolitis grade II or above, moderate-to-severe bronchopulmonary dysplasia, severe bronchopulmonary dysplasia, retinopathy of prematurity, treatment abandonment due to poor prognosis, and discharge on home oxygen therapy (all P<0.05). Total hospital length of stay and total hospitalization costs were also significantly increased in the failed extubation group (all P<0.05). CONCLUSIONS Gestational age <28 weeks, younger age at NICU admission, and FiO₂≥35% after extubation are high-risk factors for first extubation failure in neonates. Extubation failure markedly increases the risk of adverse clinical outcomes.
Humans ; Infant, Newborn ; Male ; Female ; Airway Extubation/adverse effects* ; Risk Factors ; Retrospective Studies ; Respiration, Artificial/methods* ; Intensive Care Units, Neonatal ; Prognosis ; Gestational Age ; Bronchopulmonary Dysplasia ; Infant, Premature ; Treatment Failure ; Intubation, Intratracheal

[This corrects the article DOI: 10.1016/j.apsb.2019.01.013.].

Objective To explore the temporal characteristics and correlation between active exercise rehabilitation behaviour and related symptoms in middle-aged chronic obstructive pulmonary disease(COPD)patients,and to provide a basis for constructing a full cycle precision rehabilitation management system.Methods The ecological momentary assessment method was used to select 63 middle-aged COPD patients from the respiratory and critical care medicine department of a tertiary comprehensive hospital in Wuhan from October 15 to December 1,2024,using convenience sampling.Their active exercise rehabilitation behaviour(number of exercise projects,duration)and related symptoms(dyspnea,fatigue,anxiety)were continuously monitored for a week by using baseline survey,daily active exercise rehabilitation behavior assessment questionnaire,daily symptom assessment questionnaire.A multi-layer linear model was used to analyze the dynamic correlation between active exercise rehabilitation behaviour and symptoms.Results 58 patients were included.During the 1-week ecological momentary assessment,the system triggered a total of 1,218 momentary assessments and obtained 1,120 valid responses(with the valid response rate of 91.95％),with patients completing an average of(2.76±0.39)assessments per day.Multilevel linear models showed that momentary dyspnoea,fatigue,anxiety symptoms and baseline kinesiophobia all significantly negatively influenced active exercise rehabilitation behaviour(P＜0.05).Conclusion There are dynamic changes in the active exercise rehabilitation behaviour and related symptoms of middle-aged COPD patients.Nursing staff should establish a precise rehabilitation intervention system based on symptom fluctuations,strengthen patient self-management efficiency through dynamic monitoring and hierarchical management,and achieve long-term optimization of lung rehabilitation effects.

Objective To establish a stable,reliable,and clinically relevant porcine model of endotoxin-induced acute respiratory distress syndrome(ARDS).Methods Ten 8-month-old male Bama minipigs were deeply sedated,followed by invasive mechanical ventilation and electrocardiographic monitoring.Lipopolysaccharide(LPS)was intravenously pumped at 600 μg/(kg·h)for 3 hours,then maintained at 15 μg/(kg·h)thereafter.Dynamic monitoring was performed at five time points after LPS injection(LPS 0,1,3,5,and 8 h),including arterial blood gas analysis and chest computed tomography(CT)scans.Pathological examination of lung tissues obtained via bronchoscopic biopsy(HE staining and transmission electron microscopy)was conducted.These indicators were comprehensively used to evaluate the success of the animal model.Results At 5 hours after LPS administration,8 minipigs developed symptoms such as skin cyanosis,elevated body temperature,and respiratory distress.The oxygenation index decreased to<300 mmHg.Chest CT scans showed diffuse pulmonary infiltrates.Histopathology revealed alveolar edema and hyaline membrane formation.Transmission electron microscopy demonstrated disruption of pulmonary blood-air barrier,depletion of lamellar bodies in type Ⅱ pneumocytes,inflammatory cell infiltration,and exudation of plasma proteins and fibrin.Compared with LPS 0 h,at LPS 8 h,the oxygenation index and arterial blood pH were significantly decreased(P<0.001),while blood lactic acid and serum potassium were significantly increased(P<0.05);serum calcium and base excess were significantly decreased(P<0.05),and the lung injury score based on HE-stained lung sections was significantly increased(P<0.01).Conclusion The porcine ARDS model established by continuous LPS injection can dynamically simulate the pathophysiological characteristics and typical pathological manifestations of clinical septic ARDS,making it an effective tool to study the pathogenesis,prevention,and treatment strategies of septic ARDS.

Objective:To investigate the death risk of gastric cancer patients with different primary sites.Methods:The data of 35 263 gastric cancer patients from 2004 to 2015 were extracted from of the National Cancer Institute the Surveillance, Epidemiology, and End Results (SEER) database. According to the recorded causes of death, the treatment outcomes were classified into 3 categories: death from gastric cancer, death from non-gastric cancer and others. All included patients were grouped by age, gender, race, region, and marital status. Statistical analysis was conducted by using R 4.2.1 software to compare the composition of patients with different treatment outcomes at 3-year, 5-year, and 10-year in each factor subgroup. Univariate Fine-Gray competing model was used to analyze the cumulative incidence of death at 3-year, 5-year, and 10-year in gastric cancer patients with different primary sites. The 5 factors mentioned above were included in the multivariate Fine-Gray competing model to analyze the factors influencing the risk of death from gastric cancer in the entire population at 3-year, 5-year, and 10-year and in gastric cancer patients with different primary sites for 10 years in each factor subgroup after adjusting for demographic differences.Results:Among the entire population, there were 13 392 cases of cardia, 2 198 cases of gastric fundus, 4 510 cases of gastric body, 8 394 cases of antrum, 1 154 cases of pylorus, 3 633 cases of lesser curvature, and 1,982 cases of greater curvature. There were statistically significant differences in the composition of 3-year, 5-year, and 10-year treatment outcomes including death from gastric cancer, non-gastric cancer and other outcomes of gastric cancer patients stratified by different age, gender, race, region, marital status, and primary sites of tumors among subgroups (all P < 0.001). Univariate Fine-Gray model analysis showed that the cumulative incidence of death from gastric cancer was 29.0%, 30.9% and 31.6%, respectively at 3-year,5-year and 10-year after the confirmed diagnosis in gastric cancer patients with primary sites in the cardia, which was all lower than that in those with primary site in the gastric fundus (44.5%, 46.8%, 47.7%), the gastric body (49.1%, 46.8%, 53.5%), the antrum (51.4%, 54.7%, 56.1%), the pylorus (53.6%, 57.8%, 59.8%), the lesser curvature (44.4%, 48.4%, 50.0%), and the greater curvature (42.4%, 45.0%, 46.4%). Multivariate Fine-Gray model analysis showed that the 3-year, 5-year, and 10-year mortality risks of gastric cancer patients with the primary site in the cardia were all lower than those of patients with the primary sites in other locations (all HR > 1, P < 0.001); taking the 10-year death from gastric cancer as an example, the death risks of gastric cancer patients with the primary site in the fundus ( HR = 1.74, 95% CI: 1.62-1.86), gastric body ( HR = 2.03, 95% CI: 1.93-2.14), gastric antrum ( HR = 2.13, 95% CI: 2.04-2.23), pylorus ( HR = 2.28, 95% CI: 2.11-2.47), lesser curvature ( HR = 1.76, 95% CI: 1.67-1.86), and greater curvature ( HR = 1.64, 95% CI: 1.53-1.76) were all higher than those of patients with primary site in the cardia (all P < 0.001). The results of subgroup multivariate Fine-Gray model analysis showed that there were no statistically significant differences in the 10-year death risk of gastric cancer between gastric cancer patients with other primary sites and patients with primary site in the cardia in the age group under 30 years (gastric fundus, gastric body, gastric antrum, lesser curvature, greater curvature), the black group (gastric fundus and lesser curvature) and other races group (gastric fundus, greater curvature and lesser curvature)(all P > 0.05); the results of other subgroups were the same as those of the entire population, namely, the 10-year risk of death from gastric cancer in patients with primary site in the cardia was lower than that in patients without primary site in the cardia (all HR > 1, P < 0.05). Conclusions:In SEER database, the patients with primary site in the cardia has a lower risk of death from gastric cancer compared to those with other primary sites.

Objective To explore the temporal characteristics and correlation between active exercise rehabilitation behaviour and related symptoms in middle-aged chronic obstructive pulmonary disease(COPD)patients,and to provide a basis for constructing a full cycle precision rehabilitation management system.Methods The ecological momentary assessment method was used to select 63 middle-aged COPD patients from the respiratory and critical care medicine department of a tertiary comprehensive hospital in Wuhan from October 15 to December 1,2024,using convenience sampling.Their active exercise rehabilitation behaviour(number of exercise projects,duration)and related symptoms(dyspnea,fatigue,anxiety)were continuously monitored for a week by using baseline survey,daily active exercise rehabilitation behavior assessment questionnaire,daily symptom assessment questionnaire.A multi-layer linear model was used to analyze the dynamic correlation between active exercise rehabilitation behaviour and symptoms.Results 58 patients were included.During the 1-week ecological momentary assessment,the system triggered a total of 1,218 momentary assessments and obtained 1,120 valid responses(with the valid response rate of 91.95％),with patients completing an average of(2.76±0.39)assessments per day.Multilevel linear models showed that momentary dyspnoea,fatigue,anxiety symptoms and baseline kinesiophobia all significantly negatively influenced active exercise rehabilitation behaviour(P＜0.05).Conclusion There are dynamic changes in the active exercise rehabilitation behaviour and related symptoms of middle-aged COPD patients.Nursing staff should establish a precise rehabilitation intervention system based on symptom fluctuations,strengthen patient self-management efficiency through dynamic monitoring and hierarchical management,and achieve long-term optimization of lung rehabilitation effects.

Objective:To investigate the death risk of gastric cancer patients with different primary sites.Methods:The data of 35 263 gastric cancer patients from 2004 to 2015 were extracted from of the National Cancer Institute the Surveillance, Epidemiology, and End Results (SEER) database. According to the recorded causes of death, the treatment outcomes were classified into 3 categories: death from gastric cancer, death from non-gastric cancer and others. All included patients were grouped by age, gender, race, region, and marital status. Statistical analysis was conducted by using R 4.2.1 software to compare the composition of patients with different treatment outcomes at 3-year, 5-year, and 10-year in each factor subgroup. Univariate Fine-Gray competing model was used to analyze the cumulative incidence of death at 3-year, 5-year, and 10-year in gastric cancer patients with different primary sites. The 5 factors mentioned above were included in the multivariate Fine-Gray competing model to analyze the factors influencing the risk of death from gastric cancer in the entire population at 3-year, 5-year, and 10-year and in gastric cancer patients with different primary sites for 10 years in each factor subgroup after adjusting for demographic differences.Results:Among the entire population, there were 13 392 cases of cardia, 2 198 cases of gastric fundus, 4 510 cases of gastric body, 8 394 cases of antrum, 1 154 cases of pylorus, 3 633 cases of lesser curvature, and 1,982 cases of greater curvature. There were statistically significant differences in the composition of 3-year, 5-year, and 10-year treatment outcomes including death from gastric cancer, non-gastric cancer and other outcomes of gastric cancer patients stratified by different age, gender, race, region, marital status, and primary sites of tumors among subgroups (all P < 0.001). Univariate Fine-Gray model analysis showed that the cumulative incidence of death from gastric cancer was 29.0%, 30.9% and 31.6%, respectively at 3-year,5-year and 10-year after the confirmed diagnosis in gastric cancer patients with primary sites in the cardia, which was all lower than that in those with primary site in the gastric fundus (44.5%, 46.8%, 47.7%), the gastric body (49.1%, 46.8%, 53.5%), the antrum (51.4%, 54.7%, 56.1%), the pylorus (53.6%, 57.8%, 59.8%), the lesser curvature (44.4%, 48.4%, 50.0%), and the greater curvature (42.4%, 45.0%, 46.4%). Multivariate Fine-Gray model analysis showed that the 3-year, 5-year, and 10-year mortality risks of gastric cancer patients with the primary site in the cardia were all lower than those of patients with the primary sites in other locations (all HR > 1, P < 0.001); taking the 10-year death from gastric cancer as an example, the death risks of gastric cancer patients with the primary site in the fundus ( HR = 1.74, 95% CI: 1.62-1.86), gastric body ( HR = 2.03, 95% CI: 1.93-2.14), gastric antrum ( HR = 2.13, 95% CI: 2.04-2.23), pylorus ( HR = 2.28, 95% CI: 2.11-2.47), lesser curvature ( HR = 1.76, 95% CI: 1.67-1.86), and greater curvature ( HR = 1.64, 95% CI: 1.53-1.76) were all higher than those of patients with primary site in the cardia (all P < 0.001). The results of subgroup multivariate Fine-Gray model analysis showed that there were no statistically significant differences in the 10-year death risk of gastric cancer between gastric cancer patients with other primary sites and patients with primary site in the cardia in the age group under 30 years (gastric fundus, gastric body, gastric antrum, lesser curvature, greater curvature), the black group (gastric fundus and lesser curvature) and other races group (gastric fundus, greater curvature and lesser curvature)(all P > 0.05); the results of other subgroups were the same as those of the entire population, namely, the 10-year risk of death from gastric cancer in patients with primary site in the cardia was lower than that in patients without primary site in the cardia (all HR > 1, P < 0.05). Conclusions:In SEER database, the patients with primary site in the cardia has a lower risk of death from gastric cancer compared to those with other primary sites.